Provider Demographics
NPI:1538405600
Name:DENTAL INC II, PC
Entity type:Organization
Organization Name:DENTAL INC II, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-541-3004
Mailing Address - Street 1:25225 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1462
Mailing Address - Country:US
Mailing Address - Phone:313-541-3004
Mailing Address - Fax:313-541-3038
Practice Address - Street 1:25225 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1462
Practice Address - Country:US
Practice Address - Phone:313-541-3004
Practice Address - Fax:313-541-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689782906Medicaid